Surgery for atrial fibrillation

Surgical treatment is highly effective in converting atrial fibrillation back to sinus rhythm and significantly prevents thromboembolism postoperatively. Indications for surgery include patients with atrial fibrillation associated with structural heart disease who undergo cardiac surgical procedures, high-risk patients for systemic thromboembolic complications related to left atrial thrombi, patients with failure or recurrence following one or more sessions of catheter ablation, and patients with intolerable symptoms or an impaired quality of life due to atrial fibrillation. The maze and radial procedures cure atrial fibrillation in the majority of patients, however, the procedures are not guided by electrophysiologic findings in individual patients, and thus may include unnecessary incisions in some patients or be inappropriate for other patients. Intraoperative mapping may facilitate determining the optimal procedure for atrial fibrillation in each patient. Surgical procedure for atrial fibrillation consists of isolation of all four pulmonary veins to prevent propagation of the repetitive activation and multiple incisions on the right and left atria to block the reentrant activation. A number of ablation devices have been developed to make a complete conduction block during the past decade. The challenge in atrial fibrillation surgery is in the development and establishment of an off-pump thoracoscopic procedure. Furthermore, intraoperative electrophysiological assessment of the mechanism of atrial fibrillation and verification of conduction block over the ablation line should be established to accomplish a high success rate for atrial fibrillation.